Ketosis and Diabetic Ketoacidosis: How Do They Differ? | Everyday Health

一瓶酮症测试条和救护车 — You can test to see whether you've achieved ketosis, which in the short term is harmless for most people, with urine test strips (left). Meanwhile, diabetic ketoacidosis is a health emergency that is more common among people with type 1 diabetes than type 2 diabetes. Wiikimedia Commons; Thinkstock

Ketosis和ketoacidosis sound similar and are sometimes confused, but don’t mistake these conditions for one another. These involve two different sets of circumstances with considerably different outlooks.

两者都是通过增加的ketonesin the body, which are acids released into the bloodstream when the body burns fat for energy instead of carbohydrates. But it’s how the body responds to this increase that sets ketosis andketoacidosis除了彼此。

什么是酮症和Proc如何ess Work?

“Ketosis is a natural state that occurs when you start to metabolize fat instead of sugar,” says Michael Greenfield, MD, endocrinologist and chief medical officer at El Camino Hospital in Palo Alto, California. “It occurs often when people fast and use up the stores of sugar in their body."

要了解酮症，它有助于了解人体如何燃烧能量。碳水化合物和脂肪都是能源，人体通常首先燃烧碳水化合物（糖或葡萄糖），然后燃烧脂肪。如果您的系统中没有足够的碳水化合物，它会开始分解脂肪以获得能量，从而使您的身体处于酮症状态。

While in this state, the body becomes a fat-burning machine. For this reason, ketosis is the goal of many diets, particularly those that restrictcarbohydrateintake and rely on fat for energy, such asthe ketogenic diet.

Understanding the Relationship Between the Ketogenic Diet and Ketosis

“Theketogenic dietis a high-fat (60 to 80 percent of your total daily calories), moderate-protein (10 to 15 percent of your total daily calories), and低碳水化合物饮食(less than 10 percent of your total daily calories) that forces your body into ketosis, where it burns fat as its primary source for energy,” says Deborah Malkoff-Cohen, RD, CDE, and founder of City Kids Nutrition, a nutritional consultation service for children in New York City. “Think of the oldAtkinsplan where your ex-boyfriend would eat slabs of bacon, eggs, and a porterhouse steak, and lose 21 pounds in a month.”

But although the ketogenic diet is similar to Atkins, it’s not the same. Atkins is a high-protein diet, whereas the ketogenic diet is a high-fat diet.

Malkoff解释说，生酮饮食可通过重新布线起作用代谢so that it can burn fat more efficiently over time, and it uses specific levels of macronutrients (fats, carbs, and proteins) to keep the body in a constant state of ketosis. Because the body can only go into ketosis when it’s using fat for fuel, this is a hard diet to follow, and it often means saying goodbye to starchy veggies, like potatoes, rice, corn, squash, dairy, some fruits, bread, and beans that are too carb-y, she says. The plan has become popular among people with type 2 diabetes because of its potential to lower blood sugar while leading to weight loss.

对于能够坚持下去的人，生酮饮食可以减少食欲并降低triglycerides- 一种可能影响心脏病风险的脂肪形式 - 同时导致体重减轻和大脑功能更清晰. But this doesn’t mean the ketogenic diet is right for everyone. Particularly, people with kidney damage, women who are breast-feeding or pregnant, and some individuals on certain kinds of medication should avoid ketosis. It's important to discuss your diet goals with your doctor before trying to achieve this state.

Also important to note is there are no long-term studies on ketosis and the ketogenic diet, so it's unclear what health effects the approach may have on the body if sustained. Some dietitians warn the ketogenic diet may lead to nutritionaldeficienciesin the long run.

People with type 1 diabetesshould not try to achieve ketosis through the ketogenic diet or otherwise. Because people with type 1 diabetes don't have insulin, they cannot metabolize ketones, which are gradually flushed through urine in people without the disease. For people with type 1 diabetes, ketosis can result in an accumulation of ketone acids in their bloodstream known asdiabeticketoacidosis (DKA), says Dr. Greenfield.

什么是糖尿病性酮症酸中毒？

“[Ketoacidosis] is caused by a lack of insulin available for the cells to adequately uptake the sugar (glucose) in the blood to use for energy,” explains Malkoff-Cohen. “Without enough insulin, your body begins to break down fat for energy, and ketones are then released into the bloodstream, where they cause a chemical imbalance in the blood called metabolic acidosis.”

酮症是天然且无害的，但如果未经治疗，糖尿病性酮症酸中毒可能会威胁生命。血液中过多的酸会毒害身体，导致意识和死亡的丧失。酮症酸中毒在患有1型糖尿病的人中最常见，但由于低胰岛素水平，有时会在2型糖尿病中发育。

Ketoacidosis is rare in people without diabetes, but it might occur in cases of starvation. Astudy published in October 2015 in theJournal of Medical Case Reportsfound that a low-carbohydrate diet combined with lactation could potentially induce ketoacidosis in women without diabetes, but more research is needed.

Poordiabetes management, or not having enough insulin in your system, is one cause of ketoacidosis. Other factors include developing an infection (such as肺炎or aurinary tract infection），滥用药物或酒精，或服用影响您身体使用糖的药物。例如，皮质类固醇，用于Crohn’s disease除其他健康状况外，哮喘可能使您的细胞更难使用胰岛素，而diuretics，用于控制心脏病，可以increase blood glucose levels.

糖尿病酮症酸中毒能迅速发展,sometimes within 24 hours. The condition is responsible for more than 130,000 admissions to the hospital, as well as 50,000 hospital days per year in the United States, according to anarticle published in the journalDiabetes Management. According to anarticle published in March 2013 inAmerican Family Physician, diabetic ketoacidosis is the leading cause of death among people with diabetes who are under age 24.

糖尿病性酮症酸中毒的症状包括：

Excessive thirst
Frequent urination
呕吐
Weakness
Shortness of breath
Fruity-smelling breath
混乱

How to Treat Diabetic Ketoacidosis

If you have diabetes, not only should you monitor your blood sugar on a regular basis, you should also maintain a supply of ketone urine test strips, and then check your ketone level whenever your blood sugar rises above 250 milligrams per deciliter (mg/dL).

If test strips detect ketones in your urine, begin self-treatment by drinking plenty of fluids to flush ketones from your body, and then take insulin tobring down your blood sugar. If your ketone level doesn’t come down, or if you begin vomiting, go to the emergency room.

医院治疗涉及补液以替代因排尿过多或呕吐而损失的液体，替代电解质以维持心脏，神经和细胞功能以及insulin therapyto regulate your blood sugar level. Your doctor may also screen for infections or modify your medication.

Tips to Prevent Ketoacidosis

Ketoacidosis is preventable in people who have type 1 and type 2 diabetes. To avoid this potentially life-threatening complication:

Take your糖尿病药物按照指示，不要跳过胰岛素剂量。
Monitor your blood sugar and ketones every couple of hours while sick.
Drink plenty of fluids while sick to preventdehydration，每小时约8盎司无咖啡因的饮料。
Continue taking insulin while sick, even if you’re not eating a lot.

建议对糖尿病患者进行体育锻炼，但不要忘记在锻炼前检查您的血糖水平。用升高的血糖锻炼可能会引发糖尿病性酮症酸中毒。

A safe blood sugar level for exercise is 100 to 250 mg/dL. If your level is lower than 100 mg/dL, eat a preworkout snack to boost your blood sugar and energy (between 15 and 30 grams of carbs). Don’t work out if your blood sugar level is higher than 250 mg/dL.

酮症与糖尿病性酮症酸中毒的外卖

酮症和酮症酸中毒听起来可能相似，但是这些条件完全不同。前者可能会出现低碳水化合物饮食而不有害，而后者是威胁生命的complication of type 1 diabetes(and sometimes type 2 diabetes) that can cause a dangerous level of acid in the blood.